By Gil F. Chavez, M.D.
The United States is currently experiencing the largest person-to-person hepatitis A outbreak — which is predominantly affecting people who are homeless or who use drugs in unsanitary conditions — in more than two decades.
At the same time, the California Department of Public Health (CDPH), is closely monitoring an increase in hepatitis A infections among gay, bisexual, and other men who have sex with men (MSM).
From January through December 2017, 59 cases of hepatitis A among MSM were reported in California. For perspective, during the same time period last year, there were 14. Although most of the cases among MSM are not part of the larger outbreak of hepatitis A, the increase is significant and has health officials concerned.
California isn’t alone in identifying an increase in HAV cases among MSM. According to the European Centre for Disease Prevention and Control, as of Dec. 18, 2017, there have been 3,813 cases reported in 22 European countries. Additionally, the Centers for Disease Control and Prevention has reported dozens of cases in Colorado and New York City.
So, what is hepatitis A? Hepatitis A is a viral infection of the liver caused by a virus with the same name. Typically, the virus spreads in settings with limited sanitation (such as toilets and hand-washing facilities), or by consuming contaminated food or water.
For MSM, the main risk factor is related to sexual transmission, particularly oral-anal sexual contact. Symptoms may include fatigue, lack of appetite, nausea, diarrhea and jaundice. However, adults, particularly those with other underlying liver disease, are at higher risk of severe or fatal infection. The good news is you can protect yourself.
The best way to prevent hepatitis A infection is to get vaccinated. The hepatitis A vaccine is very effective. Since 1996, the Advisory Committee on Immunization Practices has recommended that all MSM receive two doses of hepatitis A vaccine administered at least six months apart. The first dose of hepatitis A vaccine protects more than 90 percent of those who receive it and a second dose protects more than 95 percent. The hepatitis A antibody can persist for at least 20 years in adults who received the vaccine as children.
A state declaration in October provided emergency funds and a mechanism to purchase doses directly from the manufacturer. The declaration allows CDPH to manage vaccine distribution and supply so people most at risk are vaccinated first to help stop the outbreak. For vaccine distribution, CDPH has prioritized the counties where hepatitis A is spreading or have outbreak cases. CDPH is then fulfilling orders from other counties, based on current available vaccine supply, the potential for spread in the county, and the local health department’s vaccination plans.
Since April 2017, the department has provided nearly 120,000 doses of the hepatitis A vaccine for outbreak prevention and control statewide. Vaccine is available in the private sector for administration to high-risk groups, including MSM.
For more information, talk to your doctor, call your local health department, or visit this CDPH webpage or the Centers for Disease Control and Prevention.
— Dr. Gil F. Chavez, MPH, is a state epidemiologist and deputy director for infectious diseases at the California Department of Public Health. For more information, visit bit.ly/2iAjeeY.